Topical corticosteroids for atopic dermatitis

Examples

Several corticosteroid creams and ointments are available for controlling atopic dermatitis symptoms. These products are classified according to potency, ranging from group I (the most potent) through group VIII (the least potent). They are prescribed according to the type of rash you have.

Non-prescription

Generic Name	Brand Name
hydrocortisone	Aveeno Anti-Itch cream, Dermarest, Hyderm

Prescription, low strength

Generic Name	Brand Name
hydrocortisone	Cortate cream or ointment

Prescription, medium strength

Generic Name	Brand Name
betamethasone dipropionate	Diprosone lotion
fluticasone propionate	Cutivate ointment
hydrocortisone valerate	Westcort cream
triamcinolone acetonide	Triaderm cream

Prescription, high strength

Generic Name	Brand Name
betamethasone dipropionate	Diprosone cream
fluocinonide	Lidex cream, Lidex ointment
triamcinolone acetonide	Aristocort ointment

Prescription, very high strength

Generic Name	Brand Name
betamethasone dipropionate	Diprolene ointment
clobetasol propionate	Dermovate ointment and cream

Corticosteroid preparations are applied to the skin 1 to 4 times a day, depending on the strength of the preparation and your age.

How It Works

Corticosteroids are similar to natural substances the body produces. In atopic dermatitis, corticosteroids reduce inflammation, itching, and thickening of the skin (lichenification).

Why It Is Used

Topical corticosteroids are prescribed for atopic dermatitis rashes. High-strength preparations can be used on thickened skin. Avoid using high-strength topical corticosteroids on the face.

How Well It Works

Topical corticosteroids, in combination with aggressive moisturizing, are the most commonly used and effective treatment for atopic dermatitis.¹ For most people, using a topical corticosteroid for 2 to 3 days significantly clears the rash. Thickened skin requires longer treatment.

To gain the best results from topical corticosteroid treatment, apply moisturizer after each corticosteroid treatment and at least one other time during the day.

In some cases, wrapping the area with a bandage, called an occlusive dressing, may improve atopic dermatitis.² However, high-strength corticosteroids combined with an occlusive dressing can increase the risk of skin thinning and other side effects.²

Side Effects

Side effects include the following:

• A burning sensation, itching, irritation, dryness, or redness may develop in the area where the medication is applied.
• With long-term use, high-strength topical corticosteroids cause temporary thinning of the skin, making it more easily irritated. However, when used carefully and mostly in low-strength doses, topical corticosteroids can be used for up to 10 years without severe side effects.
• Corticosteroids can be absorbed through the skin and cause problems throughout the body. Side effects include headache, indigestion, increased appetite, restlessness, and increased risk of infection. If you experience skin rash, blurred vision, increased urination, excessive thirst, or mood changes, see your health professional.

Side effects are associated with long-term use of corticosteroids. You and your health professional must watch for side effects and weigh them against the potential benefit of corticosteroid treatment.

The face is especially sensitive to thinning of the skin. Using topical corticosteroids on the face can result in enlarged blood vessels (telangiectasias), bruising, acne, and stretch marks (striae).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

• Avoid stronger corticosteroids on the sensitive skin of the face, armpits, and genital area.
• When treatment with topical corticosteroids begins, your health professional may prescribe medications in a pulse pattern. For example, you may use corticosteroids for 2 weeks. Then you stop using them for 2 weeks. Then, you apply corticosteroids for another 2 weeks. This pulse-pattern prescription may help keep the medicine from becoming less effective over time.
• One study has reported that using a high-strength corticosteroid for 3 days was as effective as using a milder corticosteroid for 7 days in mild to moderate atopic dermatitis.³
• An ointment form provides the best moisturizing effect for the skin. But ointments may be uncomfortable in warm and humid conditions because they don't allow the skin to breathe well. In these cases, creams or gels may be a better choice.
• A study has reported that after a rash has disappeared, using moisturizers daily and fluticasone propionate cream twice a week on the affected area of skin reduced the risk of the rash recurring.⁴
• Topical corticosteroids may be alternated with coal tar preparations if there is concern about corticosteroid exposure. Examples of coal tar preparations include 5% coal tar in a hydro-alcoholic gel (such as Estar) or 5% liquor carbonis detergens in a cream base.
• When using a topical corticosteroid for longer periods of time, it is important to phase out its use gradually over 2 to 4 weeks, replacing it with a moisturizer or a coal tar product.

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Author:	Douglas Dana Robin Parks, MS	Last Updated: July 26, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Tom Bailey, MD - Family Medicine Randall D. Burr, MD - Dermatology
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